Scaling-up antiretroviral therapy in Malawi

In Malawi, health-system constraints meant that only a fraction of people infected with human immunodeficiency virus (HIV) and in immediate need of antiretroviral treatment (ART) received treatment. In 2004, the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the p...

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Bibliographic Details
Published in:Bulletin of the World Health Organization 2016-10, Vol.94 (10), p.772-776
Main Authors: Jahn, Andreas, Harries, Anthony D, Schouten, Erik J, Libamba, Edwin, Ford, Nathan, Maher, Dermot, Chimbwandira, Frank
Format: Article
Language:English
Subjects:
Accreditation
Acquired immune deficiency syndrome
AIDS
Anti-Retroviral Agents - therapeutic use
Antiretroviral agents
Antiretroviral therapy
Benchmarks
Breastfeeding & lactation
Clinical outcomes
Clinics
Drug therapy
Electronic health records
Embedded systems
Female
Funding
Health care facilities
Health care policy
Health facilities
Health Services Accessibility
Healthcare Disparities
HIV
HIV Infections - drug therapy
HIV-1 - drug effects
Hospitals
Human immunodeficiency virus
Humans
Immune system
Implementation
Leadership
Lentivirus
Lessons from the Field
Malawi
Male
Medical records
Monitoring systems
Mortality
Nurses
Operations research
Patients
Program Development
Public Health
Public sector
Retroviridae
Scaling
Supervision
Therapy
Training
Treatment programs
Tuberculosis
Viruses
Womens health
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Summary:In Malawi, health-system constraints meant that only a fraction of people infected with human immunodeficiency virus (HIV) and in immediate need of antiretroviral treatment (ART) received treatment. In 2004, the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the principle of equity to ensure fair geographical access to therapy. A public health approach was used with standardized training and treatment and regular supervision and monitoring of the programme. Before the scale-up, an estimated 930 000 people in Malawi were HIV-infected, with 170 000 in immediate need of ART. About 3000 patients were on ART in nine clinics. By December 2015, cumulatively 872 567 patients had been started on ART from 716 clinics, following national treatment protocols and using the standard monitoring system. Strong national leadership allowed the ministry of health to implement a uniform system for scaling-up ART and provided benchmarks for implementation on the ground. New systems of training staff and accrediting health facilities enabled task-sharing and decentralization to peripheral health centres and a standardized approach to starting and monitoring ART. A system of quarterly supervision and monitoring, into which operational research was embedded, ensured stocks of drug supplies at facilities and adherence to national treatment guidelines.
ISSN:0042-9686
1564-0604
DOI:10.2471/BLT.15.166074